“Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

These were Winston Churchill’s words in November 1940 after a seemingly endless series of defeats fighting the Germans in WWII was succeeded by a victory. There were still four years of bloody fighting and countless deaths ahead, but the first glimmers of eventual triumph could finally be discerned.

This is not the end of the tyranny of “breast is best.” It is not even the beginning of the end. But it is, perhaps, the end of the beginning.

That’s how I feel about the fact that even the most ardent lactivists have been forced to acknowledge the fundamental tenets of the Fed Is Best Foundation. No matter that the lactivists themselves don’t realize that they are now on the defensive and actually think that they are still fighting against the idea that fed is best. The first glimmers of eventual triumph of sane breastfeeding policy are coming into view.

What are the central tenets of the Fed Is Best philosophy? In my view they are:

Breastfeeding is just one of two excellent ways to feed a baby.

It is more important for a baby to be fully fed with formula than underfed with breastmilk.

Inadequate breastmilk is common, not rare, especially in the first few days after birth.

Mothers should be taught the signs of infant starvation.

Healthcare providers to rule out potentially deadly complications of exclusive breastfeeding INSTEAD of offering only reassurance.

These tenets are in direct contrast to the false claims made by lactivists that formula is substandard, inadequate breastmilk is vanishingly rare, infant starvation never happens, and the only thing a new breastfeeding mother needs is reassurance to continue breastfeeding exclusively no matter what happens to her baby.

What is cluster feeding? It’s the habit that some babies have of nursing multiple times over a few hours in preparation for an extended period of sleep. How can we tell the difference between true cluster feeding and a desperately hungry infant feeding in clusters then falling asleep due to exhaustion despite still being hungry? Sometimes it’s not easy, but it is very important because an infant feeding in clusters is at great risk for dehydration, brain injury and even death.

Even the title of Nagle’s piece is a fallback position. It was not long ago that lactivists refused to acknowledge (and some still refuse to acknowledge) that there are many women who can’t produce enough breastmilk to adequately nourish an infant, especially in the first few days after birth. For an extreme lactivist like Nagle to even acknowledge that inadequate breastmilk production is a real possibility is a victory for the Fed Is Best campaign.

The truth of the matter is that in MOST cases (statistically speaking) a baby who is unsettled and looks for the boob immediately upon putting them down (even if they just breastfed), is actually just a baby who wants to be cuddled and breastfed, not a baby who is starving. On the flip side of that, a baby who is at the breast constantly on and off all day and night and rarely doing anything but crying whether you’re holding them or not, is not normal.

Nagle goes on to describe accurate signs of a baby who is underfed:

An unsettled baby who is crying even right after being fed and immediately looking for another breastfeed, after MOST feeds…

Not having periods of awake times and sleep times as expected…

A baby who is breastfeeding for up to an hour or more at EVERY or MOST feeds, 24/7…

Of course Nagle can’t help but offer a dig at the Fed Is Best Foundation:

There are people who will state that cluster feeding is not normal (false) … The truth … is about LOOKING AT THE WHOLE PICTURE when assessing the situation.

The issue here is semantics. The term “cluster feeding” is imprecise and open to deadly misinterpretation. The average person on hearing the term “cluster feeding” is likely to assume that it means a baby who is feeding repeatedly in a short period of time. As Nagle notes, the whole picture must be taken into account when assessing cluster feeding so a term that reflects that fact would be far better. Until lactivists figure out what that term might be it makes sense to warn mothers that cluster feeding may be a sign of starvation.

Kate Tietje of Modern Alternative Mama just wrote a piece that while ostensibly criticizing the Fed Is Best Movement actually capitulates to almost every single major tenet. It’s titled Why “Fed Is Best” is the wrong approach but it actually confirms that fed is best is the right approach.

First the whining:

… At its core, “fed is best” is simply the wrong message. The bottom line for them is, not starving a baby is the most important thing. Therefore, ‘fed’ is the ‘best.’

Duh!

But fed isn’t “best.” Fed is a minimum requirement for having a child. No one, anywhere, is suggesting that a child not get fed if breastfeeding isn’t possible. What they’re suggesting — what I’m suggesting — is that yes, it does matter what you feed your child.

That’s a straw man. No one is suggesting that it doesn’t matter what you feed your baby. Fed Is Best does NOT mean that goat’s milk or homemade formula is acceptable, let alone chicken McNuggets and cola. Fed Is Best means that it is more important to prevent starvation with formula than to let a baby starve on breastmilk. That’s a mouthful; summarizing it as Fed Is Best puts the point across to everyone but the willfully obtuse.

What do I mean when I say that Tietje capitulates?

Consider this:

Biologically speaking, breast milk is the optimal food for all newborns. This does not mean it is always optimal for other reasons. Some mothers are unable to breastfeed. Some babies struggle to breastfeed or are unable. Some mothers can breastfeed, but do not produce enough. Some mothers are struggling with PPD or with a history of sexual abuse.

Or this:

Fed is Best is missing the difference between “cluster feeding” and “frequent, unsatisfied feeding.” These are different!

No fooling! If the difference is so subtle that otherwise intelligent people are confused it’s a sign that the term cluster feeding is inappropriate, not that there’s anything wrong with the folks at Fed Is Best.

Or this:

When women or babies are not healthy (if baby needs to be in the NICU for any reason; if mom had a c-section and isn’t recovering well, etc.) then these mothers are at risk for lower milk supply and should be watched more closely… And of course, if it is discovered that they are struggling to produce, baby should be offered supplements so that s/he receives adequate nutrition.

Of course!

These quotes reflect the truth of the central tenets of Fed Is Best that I listed above.

So if Tietje agrees with the central tenets, then she agrees with Fed Is Best, right? She doesn’t think so:

They are attempting to explain away why some women have difficulties by saying that it essentially doesn’t matter if women breastfeed or not, and that breastfeeding can even be ‘bad’ or ‘dangerous’ for some mothers and babies.

Well actually it doesn’t matter whether women breastfeed or not; it’s a personal choice with benefits and risks to each option. Tietje has already acknowledged that breastfeeding can be bad or dangerous for some mothers and babies so there’s no pointing in denying that now.

What’s really bothering Tietje?

This is going to have the effect of convincing women who can and want to breastfeed, not to because it seems “too hard” or because they are worried about starving their babies.

That makes no sense. The vast majority of women DO try breastfeeding. They stop because it doesn’t work for them or for their babies. On consideration, the risks (or drawbacks) of breastfeeding outweigh the benefits for them. Tietje may not like it, but that’s her problem, not our problem.

It may seems that extreme lactivists like Nagle and Tietje are only taking baby steps, but having written about this issue for more than a decade, I can assure you that even baby steps are a momentous occurrence.

Obviously this is not the end of the tyranny of “breast is best” or the end of the Baby Friendly Hospital Initiative. It is not even the beginning of the end. but it is, perhaps, the end of the beginning of the fight to establish once and for all that Fed Is Best.

I’ve seen this tactic you describe done by pseudoscience types in a very unrelated area of fringe science I critique. This method of accepting the facts but claiming that they fit their scenario, and strawmanning the position they’ve been fighting (the fed is best position in this case) is, I think, probably fairly common in pseudoscience (I’ve noticed that all forms of pseudoscience tend toward the same tactics). It’s difficult to know if this is done unconsciously to maintain their
beliefs, or as a conscious tactic; it probably varies from person to
person.

Whether consciously or not, however, it’s dishonest and it’s good you’re pointing it out. If it isn’t pointed out (as I’ve found in the form of pseudoscience I’ve spent time critiquing) this method of theirs can be effective even among those who should know better. If it’s pointed out, again in my experience, that won’t sway the hardcore believers but can reach those who are drawn to the pseudoscience.

SporkParade

I’m not holding my breath for the lactivists to make the final step that leads me to support the FIB mission, which is that, when we deny women the choice to use formula, whether through hospital policies or social shaming, it is inevitable that someone will get hurt. Just like how pregnant women die of sepsis in countries like Ireland where you can’t get an abortion if the fetus still has a pulse. Or how babies are stillborn when mother’s request for a C-section during a long, difficult labor is refused. The only way to keep women and their babies safe is to respect bodily autonomy in all situations.

Roadstergal

OT – a gorilla needed the help of an OB to give birth. Interventions made a C-section unnecessary.

How DARE they give that poor gorilla anaesthesia and an episiotomy without her express written consent! Occiput Anterior is just a Variation of Normal; the mother could have given birth naturally without needing any harmful interventions or medications. NCT and PETA now intend to join forces to launch a lawsuit on Kira’s behalf.

kilda

they just didn’t want to let Kira be a warrior mama. Patriarchal bastards. I mean, if gorilla birth is dangerous, why are there still gorillas? You’d think they’d be endangered or something. Oh, wait….

Sue

Why is it that anyone even gives Tietje – an ex-music teacher with a few kids – the time of day?

Sarah

This is my question. She has literally nothing to recommend her.

Merrie

She claims to be self-educated and that’s all her target audience cares about because they themselves think their Google search makes them “educated”. If they actually cared about credentials and thought that credentials represented in-depth knowledge in the field, they would be reading stuff written by people who had said credentials.

AnnaPDE

“Fed is Best is missing the difference between “cluster feeding” and “frequent, unsatisfied feeding.” These are different!”

Actually it’s not Fed is Best who are confused about this, but the armies of lactivists, including LCs and bloggers, who are reassuring mums that the latter is really just the former.

Cluster feeding is when your baby downs 3 big feeds in quick succession, with a happily milk-drunk face in the intervals between the feeds. Moms are not concerned about that kind of thing.
Mums usually worry when their baby is clingy, fussy, trying to feed 24/7 and seems generally unsatisfied. And THAT is exactly when they get told that “it’s just cluster feeding”.

Milk Meg and MAM really need to stop lying through their teeth.

Sheven

Exactly. The problem isn’t that Fed is Best is inaccurate, it’s that lactivism tried to tell mothers that a signal that their baby was starving is actually a perfectly normal, healthy behavior called cluster feeding.

Pretty soon they’ll be talking about how Fed is Best is missing the difference between relaxed hands due to malnutrition and relaxed hands due to satisfaction. You guys are the ones who started the confusion! You are the ones who kept trying to tell mothers that all the signs that their baby was hungry weren’t signs that their baby was hungry!

Charybdis

“Fed is Best is missing the difference between “cluster feeding” and “frequent, unsatisfied feeding.” These are different!”
But Meg, when your best, oft-repeated, ad nauseam advice is always “When in doubt, whip it out!” and telling mothers to constantly offer the boob, that babies will breastfeed for hunger, thirst, boredom, comfort, reassurance, illness, upset, scared, tired, tantrums, sleep, solar eclipse, lunar eclipse, high tides, low tides, global warming, Halley’s Comet, shark attacks, coral bleaching, the dawning of the Age of Aquarius and a whole host of other reasons, how are you to *know* that there is frequent, unsatisfied feeding?
When you constantly say to “watch your baby, not the clock”, that “eat, play, sleep routines don’t work for breastfed babies” and that it doesn’t matter if your baby just *had boob*, if they want more boob, let them have it. In fact, cancel all your plans and just “hang out” topless with your baby so they can latch anytime they want! This is *not* helpful for mothers who are doubtful of their baby’s satiety after breastfeeding.
Telling women that pumping doesn’t give an accurate, hell, even ballpark estimate of their milk production because “the amount you can pump *just* indicates the amount you can pump, not your actual production or what the baby can remove” because babies are more efficient at removing milk than the pump, this does not help anyone who is having doubts.
She is a one trick pony and a perfect example of “if all you have is a hammer, everything looks like a nail”. Breastfeed All The Time and if you are unsure, Breastfeed MOAR! People want and need real help. She ain’t help.

MaineJen

LOL. I don’t believe in astrology even a little bit, but if ever there was a textbook Aquarius, my daughter would be it. :/

Young CC Prof

I hate that “pumping isn’t a sign” thing. If your baby is several weeks old, growing well, and you pick up a pump for the first time and can’t get much out, sure, the baby probably does a better job of extracting. (In that case, an adjustment to pumping technique might help.)

But many brand-new babies are not terribly efficient at removing milk, either. If your baby is three days old, unhappy at breast, and you pump next to nothing, the most likely explanation is that there’s nothing in there to pump.

Empress of the Iguana People

As I’ve said before, when my apple fiend was new, he cluster-fed with a vengence from 630-1030 am and pm. Then he’d sleep. I’m pretty sure since it took 2 sessions to drain one side that he was getting a lot of colostrum in the first dose. BUT it was pretty clear with his massive spit up and his nice cruising along his percentile arc that he was getting plenty on the inside

3boyz

This kind of reminds me of the way people bend like pretzels to explain why they’re not feminist but they actually agree with like 99% of what feminism is about.

Do lactivists realize the amount of effort it takes for an infant to feed?

Working all of the muscles in the mouth and tongue correctly takes a lot of energy for a newborn. The NICU nurses referred to bottle-feeding as a baby’s daily exercise. For my son, it seemed like a marathon each time.

If a baby is feeding repeatedly and not getting enough milk – or enough calories – it’s like making an adult run a marathon to get a small side salad and a single cup of water. Over and over again.

Run a marathon without water and you’ll get severe dehydration. Have a baby cluster-feed without milk and she’ll become dehydrated.

Babies have a small amount of fat reserve – but running 8-12 marathons a day in return for side salads will cause them to collapse as it would collapse all of us.

The LC who noticed my son’s weight loss and told us to supplement said the same thing, that he was burning more calories nursing than he was taking in from my milk supply. What I thought was contentment at being full was exhaustion from working so hard to get too little fluid and calories.

Tori

Exactly the same here. One morning he fed for three hours straight aight attached to me, dozing off due to exhaustion and then waking instantly if I put him down. LC had me start formula (thank goodness!). When I saw our paediatrician a few weeks later, and talked about mixed feeding, supply line, and the supply issues, I talked briefly about that 3 hour feed. Paed said it was normal. I felt so invalidated at the time. In hindsight I suspected I didn’t explain myself properly because our paed is otherwise lovely and sensible, so can’t make sense of his comment otherwise.

Gæst

Bottle feeding was so hard for my premature daughter that she couldn’t eat enough. She’d fall asleep while eating, but at weigh-ins, she wasn’t gaining weight fast enough and I had to try and wake up up and get her to eat more at every feeding until that resolved. If her growth had slowed any more than it did, she was going to get high-calorie formula, but it never came to that. It was just so much work for her to eat!

My little guy has gotten high calorie formula (24 cal) and his trusty NG tube. Thankfully, he’s gotten so good at bottle feeding that we’ve removed his NG tube for two weeks. We can always replace it if he needs it – but it’s been nice to have just an oxygen cannula that is much easier to replace when he pulls on it.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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